Pregnancy and childbearing rates for teenagers remain high in
the United States despite well-documented associated adverse
health, social, and economic consequences for many of these
teenagers and their children. In 1990, approximately 835,000 (10%)
teenagers aged 15-19 years became pregnant and either gave birth or
had an abortion (CDC, unpublished data, 1995); an estimated 95% of
such pregnancies are unintended (1). This report presents estimates
of pregnancy rates among women aged less than or equal to 19 years
for each state and the District of Columbia (DC) by age group,
pregnancy rates for women aged 15-19 years by race, and birth rates
for women aged 15-19 years by race and by Hispanic ethnicity for
1991-1992, and compares pregnancy rates for 1991 and 1992.

The numbers of pregnancies for 1991 and 1992 were estimated as
the sum of live births and legal induced abortions among women aged
less than or equal to 19 years (data were analyzed for women aged
less than 15, 15-17, 18-19, and 15-19 years); estimates of
spontaneous abortions and stillbirths were not included. Births
were reported by state of residence; because abortion data by
residence were not available for all states, abortions were
reported by state of occurrence. * Denominators for rate
calculations were obtained from intercensal population estimates
provided by the U.S. Bureau of the Census (2). Rates for 15-19-
year-olds were calculated as the number of pregnancies,
abortions, or births per 1000 women aged 15-17, 18-19, and 15-19
years. Because almost all pregnancies (97% of births and 94% of
abortions) among girls aged less than 15 years occur among those
aged 13-14 years (3; CDC, unpublished data, 1993), the number of
girls aged 13-14 years was used as the denominator when calculating
rates for the less than 15-year age group. For each state included
in rate calculations, the number of women who had abortions for
whom age or race information was missing and the number who gave
birth for whom ethnicity information was missing were included in
age, race, or ethnicity categories based on the known distributions
for abortions or births in that state. ** Differences in pregnancy,
abortion, and birth rates for 1991 and 1992 were calculated and
tested for statistical significance at p less than 0.05.

Although abortion totals were available for all states,
age-specific abortion data were available from 42 states for both
1991 and 1992; race-specific data were available from 31 states for
1991 and from 34 states for 1992. Because Hispanic ethnicity
information for women who had abortions was available for only 18
states for 1991 and 20 states for 1992, pregnancy rates by
ethnicity are not included in this report. Information was
available for birth rates by age and by race for all 50 states and
DC and by ethnicity for 49 states and DC.

For both years and for all states for which data were
available, pregnancy rates were higher for older teenagers than for
younger teenagers. Rates for 15-19-year-olds in 1991 ranged from
54.3 per 1000 women (North Dakota) to 109.2 (Georgia)
(Table_1), ***
and in 1992, from 53.7 (Wyoming) to 106.9 (Georgia). For those aged
less than 15 years, pregnancy rates in 1991 ranged from 1.8 per
1000 (Idaho) to 10.6 (Georgia) and in 1992 from 2.0 (Idaho) to 10.9
(Mississippi).

From 1991 through 1992, pregnancy rates for 15-19-year-olds
decreased significantly in 31 of the 42 states for which
age-specific data were available (range: 2%-15% decrease)
(Table_1).
In two states, rates increased significantly. Among states with
decreases in pregnancy rates, the percentage decrease was generally
greater for 15-17-year-olds than for other age groups. For those
aged less than 15 years, pregnancy rates decreased significantly in
one state and increased significantly in two.

Decreases in teenage pregnancy rates were reflected in both
birth and abortion rates. More states had decreases in abortion
rates than had decreases in birth rates, and the decreases
generally were greater for abortion rates than for birth rates. For
the 50 states and DC, birth rates for 15-19-year-olds decreased
significantly in 20 states: by less than 5% in 11 states and by
5%-9%
in nine states. Abortion rates decreased significantly in 31 of
the 42 states for which data were available: rates decreased by
less than 5% in two states, 5%-9% in six states, 10%-14% in eight
states, and 15%-27% in 15 states.

Except in one state in 1992, pregnancy rates and birth rates
by state for 15-19-year-olds were higher for blacks than for whites
(Table_2 and Table_3). Among states with decreases in
pregnancy rates, the percentage decrease generally was greater for
whites than for blacks. Birth rates generally were higher for
Hispanics
than for non-Hispanics in both 1991 and 1992.

Editorial Note

Editorial Note: The estimates in this report indicate pregnancy
rates for women aged 15-19 years decreased in 1992 from 1991 in
many states; these changes were reflected in both abortion and
birth rates. As a result, the national birth rate for
15-19-year-olds
decreased by 2% in 1992 following a 24% increase from 1986 through
1991 (4). In conjunction with a continuing decrease in abortions
(5), this change may signify a turning point in pregnancy trends
among teenagers.

Changes in pregnancy rates for women aged 15-19 years may
reflect shifts in the proportion of those who have had sexual
intercourse and the proportion who use contraception effectively.
The percentage of women in this age group who were sexually
experienced remained stable from 1990 through 1993, while the
percentage of sexually experienced teenagers who used condoms
increased, and the percentage using oral contraceptives remained
stable (6). The finding that significant decreases in pregnancy
rates occurred both in states with relatively low 1991 rates and
states with relatively high rates suggests that potential exists
for all states to achieve lower rates of pregnancy among this age
group. School-based programs that focus on the risks of unprotected
sexual intercourse and assist students in developing appropriate
values, self-efficacy, and negotiation skills appear to be
effective in postponing initiation of sexual activity and in
decreasing rates of unprotected intercourse (7). Some
community-based programs emphasize development of self-esteem and
orientation toward the future and provide sex education and
family-planning services; such programs may be effective in
decreasing rates of unprotected intercourse and potentially can
reach teenagers who are not enrolled in school.

Pregnancy and birth rates did not decrease equally for all
groups of teenagers. For example, pregnancy rates for those aged
less than 15 years decreased significantly in only one state. In
addition, percentage decreases in pregnancy rates for
15-19-year-olds
were greater for whites than for blacks; consequently, both
pregnancy and birth rates remained higher for blacks than whites.
In addition, birth rates remained higher for Hispanics than
for non-Hispanics. Differences in these rates by race and ethnicity
may reflect differences in factors such as income, education
levels, sexual activity, reproductive preferences, contraceptive
use, and access to health care. Analysis of these factors could
identify reasons for the differences in rates and suggest possible
interventions to reduce these rates.

The estimation in this report of pregnancy rates for teenagers
was limited by the lack of complete abortion data for some states.
In addition, pregnancy totals based on births and legal induced
abortions reported to CDC may underestimate the actual number of
pregnancies. In 1990, approximately 835,000 live births and
abortions among 15-19-year-olds were reported in the United States
to CDC (CDC, unpublished data, 1995). In contrast, a recent
analysis using alternative methodology and including fetal losses
estimated approximately 1 million pregnancies among 15-19-year-olds
in the United States during 1990 (8,9).

Accurate monitoring of pregnancy trends requires complete
reporting of age, race, and Hispanic ethnicity for those who have
abortions as well as those who give birth. Birth patterns cannot be
used to estimate trends in pregnancy because the ratio of
pregnancies to births varies by state, age, race, and ethnicity.
Therefore, efforts by states to collect complete abortion data are
essential for evaluating the progress of pregnancy-prevention
programs for teenagers.

Bureau of the Census. Estimates of the population of states, by
age, race, sex, and Hispanic origin, 1990-92. Washington, DC: US
Department of Commerce, Bureau of the Census, Statistical
Information Office, Population Division (in press).

* For 47 reporting areas, data were provided from the central
health agency (state health departments and the health departments
of DC, upstate New York, and New York City). Data from upstate New
York and New York City were combined to produce totals for the
state. For the other five states, data were provided from hospitals
and other medical facilities. The word "state" in this report
refers to both states and DC except where DC is mentioned
explicitly. Wisconsin and DC reported age for those who had
abortions among residents only.

** Reasons for the exclusion of rates in some states are listed in
the tables; the following hierarchy was used to determine whether
data were excluded: 1) abortion data by age or race or birth data
by Hispanic ethnicity were not reported by state; 2) less than 20
births or pregnancies or less than 1000 women were in the group;
and 3) for greater than 15% of the abortion data, age or race of
the women was unknown.

*** DC is not included in these comparisons because it is an urban
area, and pregnancy rates are generally higher in urban areas than
in states.

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